Provider Demographics
NPI:1104532621
Name:GENTILE, PHILIP GERARD (JD, MSW)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:GERARD
Last Name:GENTILE
Suffix:
Gender:M
Credentials:JD, MSW
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:G
Other - Last Name:GENTILE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JD, MDW
Mailing Address - Street 1:PO BOX 1698
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18016-1698
Mailing Address - Country:US
Mailing Address - Phone:610-653-6993
Mailing Address - Fax:
Practice Address - Street 1:6258 ROUTE 209
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7159
Practice Address - Country:US
Practice Address - Phone:610-653-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health